FamilyCare Act of 2004 - Amends title XXI of the Social Security Act (SSA) to rename the State Children's Health Insurance Program (SCHIP) the FamilyCare Program. Provides for: (1) automatic enrollment in the FamilyCare Program of children born to title XXI parents; and (2) optional family care coverage of parents of targeted low-income children and low-income pregnant women under Medicaid (SSA title XIX).
Provides for optional coverage of legal immigrants under Medicaid and SSA title XXI, and of children through age 20 under Medicaid and SSA title XXI.
Allows States to elect to provide for a period of presumptive eligibility for medical assistance for a parent of a child with respect to whom such a period is provided under Medicaid.
Revises the transitional medical assistance (TMA) program, including making reporting requirements optional, giving States the option to extend eligibility for low-income individuals for up to 12 additional months, and eliminating the sunset for TMA.
Establishes limitations with respect to marketing activities to comply with new conflict of interest requirements. Prohibits affiliation with debarred persons.
Increases the SCHIP allotment for each of FY 2002 through 2004.
Directs the Secretry to award demonstration grants to up to seven States (or other qualified entities) to conduct innovative programs designed to improve outreach to homeless individuals and families under specified programs, including Medicaid.
Limits cost-sharing under the FamilyCare program to 2.5 percent for families with income below 150 percent of poverty.
Increases Federal reimbursement for language services under the Medicaid program and SSA title XXI.
[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4350 Introduced in House (IH)]
108th CONGRESS
2d Session
H. R. 4350
To amend titles XIX and XXI of the Social Security Act to provide for
FamilyCare coverage for parents of enrolled children, and for other
purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
May 12, 2004
Mr. Dingell (for himself, Mr. Brown of Ohio, Mr. Rangel, Mr. Stark, Mr.
Waxman, Ms. Pelosi, Mr. George Miller of California, Mr. Pallone, Mr.
Abercrombie, Mr. Allen, Mr. Baca, Mr. Boucher, Mrs. Capps, Ms. Carson
of Indiana, Mrs. Christensen, Mr. Crowley, Mr. Cummings, Mr. Davis of
Florida, Ms. DeGette, Ms. DeLauro, Mr. Deutsch, Mr. Doyle, Mr. Emanuel,
Mr. Engel, Ms. Eshoo, Mr. Evans, Mr. Filner, Mr. Frank of
Massachusetts, Mr. Frost, Mr. Gephardt, Mr. Gonzalez, Mr. Gordon, Mr.
Green of Texas, Mr. Grijalva, Mr. Hinchey, Mr. Hoeffel, Ms. Jackson-Lee
of Texas, Mrs. Jones of Ohio, Mr. Kildee, Ms. Kilpatrick, Mr. Kind, Ms.
Lee, Mr. Lynch, Ms. McCarthy of Missouri, Ms. McCollum, Mr. McDermott,
Mr. McGovern, Mr. McNulty, Mr. Markey, Mr. Matsui, Mr. Meeks of New
York, Mr. Menendez, Mr. Moore, Mr. Moran of Virginia, Mr. Nadler, Mrs.
Napolitano, Mr. Pastor, Mr. Payne, Mr. Rodriguez, Ms. Roybal-Allard,
Mr. Ruppersberger, Mr. Rush, Mr. Sandlin, Ms. Schakowsky, Mr. Scott of
Virginia, Mr. Serrano, Ms. Slaughter, Ms. Solis, Mr. Strickland, Mr.
Stupak, Mr. Tierney, Mr. Weiner, Mr. Wynn, Mr. Jackson of Illinois, Mr.
Andrews, Mr. Levin, Mr. Kennedy of Rhode Island, Mr. Olver, Mr. Holt,
Mr. Kleczka, Ms. Waters, Mr. Bishop of New York, Ms. Woolsey, Mrs.
Davis of California, Mr. Ryan of Ohio, Mr. Van Hollen, Mr. Honda, Mr.
Michaud, Mr. Alexander, Mr. Wexler, Ms. Linda T. Sanchez of California,
Mr. Delahunt, Mr. Clay, Mr. Hoyer, and Mr. Kucinich) introduced the
following bill; which was referred to the Committee on Energy and
Commerce
_______________________________________________________________________
A BILL
To amend titles XIX and XXI of the Social Security Act to provide for
FamilyCare coverage for parents of enrolled children, and for other
purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``FamilyCare Act of
2004''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; table of contents.
Sec. 2. Renaming of title XXI program.
Sec. 3. FamilyCare coverage of parents and pregnant women under the
medicaid program and title XXI.
Sec. 4. Automatic enrollment of children born to title XXI parents.
Sec. 5. Optional coverage of legal immigrants under the medicaid
program and title XXI.
Sec. 6. Optional coverage of children through age 20 under the medicaid
program and title XXI.
Sec. 7. Allowing States to simplify rules for families.
Sec. 8. Revision and simplification of the transitional medical
assistance program (TMA).
Sec. 9. Limitations on conflicts of interest.
Sec. 10. Increase in CHIP allotment for each of fiscal years 2002
through 2004.
Sec. 11. Demonstration programs to improve medicaid and CHIP outreach
to homeless individuals and families.
Sec. 12. Additional CHIP revisions.
Sec. 13. Increased federal reimbursement for language services under
the medicaid program and title XXI.
SEC. 2. RENAMING OF TITLE XXI PROGRAM.
(a) In General.--The heading of title XXI of the Social Security
Act (42 U.S.C. 1397aa et seq.) is amended to read as follows:
``TITLE XXI--FAMILYCARE PROGRAM''.
(b) Program References.--Any reference in any provision of Federal
law or regulation to ``SCHIP'' or ``State children's health insurance
program'' under title XXI of the Social Security Act shall be deemed a
reference to the FamilyCare program under such title.
SEC. 3. FAMILYCARE COVERAGE OF PARENTS AND PREGNANT WOMEN UNDER THE
MEDICAID PROGRAM AND TITLE XXI.
(a) Incentives To Implement FamilyCare Coverage.--
(1) Under medicaid.--
(A) Establishment of new optional eligibility
category.--Section 1902(a)(10)(A)(ii) of the Social
Security Act (42 U.S.C. 1396a(a)(10)(A)(ii)) is
amended--
(i) by striking ``or'' at the end of
subclause (XVII);
(ii) by adding ``or'' at the end of
subclause (XVIII); and
(iii) by adding at the end the following:
``(XIX) who are individuals
described in subsection (k)(1)
(relating to parents of categorically
eligible children);''.
(B) Parents described.--Section 1902 of the Social
Security Act is further amended by inserting after
subsection (j) the following:
``(k)(1)(A) Individuals described in this paragraph are
individuals--
``(i) who are the parents of an individual who is under 19
years of age (or such higher age as the State may have elected
under section 1902(l)(1)(D)) and who is eligible for medical
assistance under subsection (a)(10)(A);
``(ii) who are not otherwise eligible for medical
assistance under such subsection or under a waiver approved
under section 1115 or otherwise (except under section 1931 or
under subsection (a)(10)(A)(ii)(XIX)); and
``(iii) whose family income or resources exceeds the
effective income level or resource level applicable under the
State plan under part A of title IV as in effect as of July 16,
1996, but does not exceed the highest effective income or
resource level (if any) applicable to a child in the family
under this title.
``(B) In establishing an income eligibility level for individuals
described in this paragraph, a State may vary such level consistent
with the various income levels established under subsection (l)(2) in
order to ensure, to the maximum extent possible, that such individuals
shall be enrolled in the same program as their children.
``(C) An individual may not be treated as being described in this
paragraph unless, at the time of the individual's enrollment under this
title, the child referred to in subparagraph (A)(i) of the individual
is also enrolled under this title or otherwise insured.
``(D) In this subsection, the term `parent' includes an individual
treated as a caretaker for purposes of carrying out section 1931.
``(E) In this subsection, the term `effective income level' means
the income level expressed as a percent of the poverty line and
considering applicable income disregards.
``(2) The State shall provide for coverage of a parent described in
paragraph (1) or section 2111 of a child who is covered under this
title or title XXI under the same title as the title as such child is
covered. In the case of a parent described in paragraph (1) who is also
the parent of a child who is eligible for child health assistance under
title XXI, the State may elect (on a uniform basis) to cover all such
parents under section 2111 or under this title.''.
(C) Enhanced matching funds available if certain
conditions met.--Section 1905 of the Social Security
Act (42 U.S.C. 1396d) is amended--
(i) in the fourth sentence of subsection
(b), by striking ``or subsection (u)(3)'' and
inserting ``, (u)(3), or (u)(4)(A)''; and
(ii) in subsection (u)--
(I) by redesignating paragraph (4)
as paragraph (6), and
(II) by inserting after paragraph
(3) the following:
``(4) For purposes of subsection (b) and section 2105(a)(1):
``(A) FamilyCare parents.--The expenditures described in
this subparagraph are the expenditures described in the
following clauses (i) and (ii):
``(i) Parents.--If the conditions described in
clauses (iii) and (iv) are met, expenditures for
medical assistance for parents described in section
1902(k)(1) and for parents who would be described in
such section but for the fact that they are eligible
for medical assistance under section 1931 or under a
waiver approved under section 1115.
``(ii) Certain pregnant women.--If the conditions
described in clause (v) are met, expenditures for
medical assistance for pregnant women described in
subsection (n) or under section 1902(l)(1)(A) in a
family the income of which exceeds the effective income
level applicable under subsection (a)(10)(A)(i)(III) or
(l)(2)(A) of section 1902 to a family of the size
involved as of January 1, 2005.
``(iii) Conditions relating to ensuring children's
coverage for enhanced match for parents.--The
conditions described in this clause are the following:
``(I) The State has a State child health
plan under title XXI which (whether implemented
under such title or under this title) has an
effective income level for children that is at
least 200 percent of the poverty line.
``(II) Such State child health plan does
not limit the acceptance of applications, does
not use a waiting list for children who meet
eligibility standards to qualify for
assistance, and provides benefits to all
children in the State who apply for and meet
eligibility standards.
``(III) Effective for determinations of
eligibility made on or after the date that is 1
year after the date of the enactment of this
clause, the application and renewal procedures
for individuals under 19 years of age (or such
higher age as the State has elected under
section 1902(l)(1)(D)) for medical assistance
under section 1902(a)(10)(A) are not to be more
restrictive or burdensome than such procedures
used for children with higher income under the
State child health plan under title XXI.
``(iv) Conditions relating to minimum coverage for
parents for enhanced match for parents.--The conditions
described in this clause are the following:
``(I) The State does not apply an income
level for parents that is lower than the
effective income level (expressed as a percent
of the poverty line) that has been specified
under the State plan under title XIX (including
under a waiver authorized by the Secretary or
under section 1902(r)(2)), as of January 1,
2005, to be eligible for medical assistance as
a parent under this title.
``(II) The State plans under this title and
title XXI do not provide coverage for parents
with higher family income without covering
parents with a lower family income.
``(v) Conditions for enhanced match for certain
pregnant women.--The conditions described in this
clause are the following:
``(I) The State has established an
effective income eligibility level for pregnant
women under subsection (a)(10)(A)(i)(III) or
(l)(2)(A) of section 1902 that is at least 185
percent of the poverty line.
``(II) The State plans under this title and
title XXI do not provide coverage for pregnant
women described in subparagraph (A)(ii) with
higher family income without covering such
pregnant women with a lower family income.
``(III) The State does not apply an income
level for pregnant women that is lower than the
effective income level that has been specified
under the State plan under subsection
(a)(10)(A)(i)(III) or (l)(2)(A) of section
1902, as of January 1, 2005, to be eligible for
medical assistance as a pregnant woman.
``(IV) The State satisfies the conditions
described in subclauses (I) and (II) of clause
(iii).
``(vi) Definitions.--For purposes of this
subsection:
``(I) The term `parent' has the meaning
given such term for purposes of section
1902(k)(1).
``(II) The term `poverty line' has the
meaning given such term in section
2110(c)(5).''.
(D) Appropriation from title xxi allotment for
certain medicaid expansion costs.--Section 2105(a) of
the Social Security Act (42 U.S.C. 1397ee(a)) is
amended--
(i) in paragraph (1), by redesignating
subparagraphs (B) through (D) as subparagraphs
(C) through (E), respectively, and by inserting
after subparagraph (A) the following new subparagraph:
``(B) for medical assistance that is attributable
to expenditures described in section 1905(u)(4)(A);'';
and
(ii) in paragraph (2), by adding at the end
the following new subparagraph:
``(E) Fifth, for expenditures for items described
in paragraph (1)(E).''.
(E) Increasing enhanced fmap to 100 percent for
fiscal years 2005 and 2006 for coverage of parents.--
Section 2105(b) of such Act (42 U.S.C. 1397ee(b)) is
amended by adding at the end the following new
sentence: ``Notwithstanding the previous sentence, the
`enhanced FMAP' shall be 100 percent with respect to
medical assistance under title XIX for expenditures
described in section 1905(u)(4)(A)(i), but only for
such assistance furnished during fiscal year 2005 and
fiscal year 2006.''.
(2) Under title xxi.--
(A) FamilyCare coverage.--Title XXI of the Social
Security Act (42 U.S.C. 1397aa et seq.) is amended by
adding at the end the following:
``SEC. 2111. OPTIONAL FAMILYCARE COVERAGE OF PARENTS OF TARGETED LOW-
INCOME CHILDREN.
``(a) Optional Coverage.--Notwithstanding any other provision of
this title, a State may provide for coverage, through an amendment to
its State child health plan under section 2102, of parent health
assistance for targeted low-income parents, health care assistance for
targeted low-income pregnant women, or both, in accordance with this
section, but only if--
``(1) with respect to the provision of parent health
assistance, the State meets the conditions described in clause
(iii) of section 1905(u)(4)(A);
``(2) with respect to the provision of health care
assistance for pregnant women, the State meets the conditions
described in clause (iv) of section 1905(u)(4)(A); and
``(3) in the case of parent health assistance for targeted
low-income parents, the State elects to provide medical
assistance under section 1902(a)(10)(A)(ii)(XIX), under section
1931, or under a waiver under section 1115 to individuals
described in section 1902(k)(1)(A)(i) and elects an effective
income level that, consistent with paragraphs (1)(B) and (2) of
section 1902(k), ensures to the maximum extent possible, that
such individuals shall be enrolled in the same program as their
children if their children are eligible for coverage under
title XIX (including under a waiver authorized by the Secretary
or under section 1902(r)(2)).
``(b) Definitions.--For purposes of this title:
``(1) Parent health assistance.--The term `parent health
assistance' has the meaning given the term child health
assistance in section 2110(a) as if any reference to targeted
low-income children were a reference to targeted low-income
parents.
``(2) Parent.--The term `parent' has the meaning given the
term `caretaker relative' for purposes of carrying out section
1931.
``(3) Health care assistance for pregnant women.--The term
`health care assistance for pregnant women' has the meaning
given the term child health assistance in section 2110(a) as if
any reference to targeted low-income children were a reference
to targeted low-income pregnant women.
``(4) Targeted low-income parent.--The term `targeted low-
income parent' has the meaning given the term targeted low-
income child in section 2110(b) as if the reference to a child
were deemed a reference to a parent (as defined in paragraph
(3)) of the child; except that in applying such section--
``(A) there shall be substituted for the income
level described in paragraph (1)(B)(ii)(I) the
applicable income level in effect for a targeted low-
income child;
``(B) in paragraph (3), January 1, 2005, shall be
substituted for July 1, 1997; and
``(C) in paragraph (4), January 1, 2005, shall be
substituted for March 31, 1997.
``(5) Targeted low-income pregnant woman.--The term
`targeted low-income pregnant woman' has the meaning given the
term targeted low-income child in section 2110(b) as if any
reference to a child were a reference to a woman during
pregnancy and through the end of the month in which the 60-day
period beginning on the last day of her pregnancy ends; except
that in applying such section--
``(A) there shall be substituted for the income
level described in paragraph (1)(B)(ii)(I) the
applicable income level in effect for a targeted low-
income child;
``(B) in paragraph (3), January 1, 2005, shall be
substituted for July 1, 1997; and
``(C) in paragraph (4), January 1, 2005, shall be
substituted for March 31, 1997.
``(c) References to Terms and Special Rules.--In the case of, and
with respect to, a State providing for coverage of parent health
assistance to targeted low-income parents or health care assistance to
targeted low-income pregnant women under subsection (a), the following
special rules apply:
``(1) Any reference in this title (other than in subsection
(b)) to a targeted low-income child is deemed to include a
reference to a targeted low-income parent or a targeted low-
income pregnant woman (as applicable).
``(2) Any such reference to child health assistance--
``(A) with respect to such parents is deemed a
reference to parent health assistance; and
``(B) with respect to such pregnant women, is
deemed a reference to health care assistance for
pregnant women.
``(3) In applying section 2103(e)(3)(B) in the case of a
family (consisting of a parent and one or more children)
provided coverage under this section or a pregnant woman
provided coverage under this section without covering other
family members, the limitation on total annual aggregate cost-sharing
shall be applied to such entire family or such pregnant woman,
respectively.
``(4) In applying section 2110(b)(4), any reference to
`section 1902(l)(2) or 1905(n)(2) (as selected by a State)' is
deemed a reference to the effective income level applicable to
parents under section 1931 or under a waiver approved under
section 1115, or, in the case of a pregnant woman, the income
level established under section 1902(l)(2)(A).
``(5) In applying section 2102(b)(3)(B), any reference to
children found through screening to be eligible for medical
assistance under the State medicaid plan under title XIX is
deemed a reference to parents and pregnant women.''.
(B) Additional allotment for states providing
familycare.--
(i) In general.--Section 2104 of the Social
Security Act (42 U.S.C. 1397dd) is amended by
inserting after subsection (c) the following:
``(d) Additional Allotments for State Providing FamilyCare.--
``(1) Appropriation; total allotment.--For the purpose of
providing additional allotments to States to provide FamilyCare
coverage under section 2111, there is appropriated, out of any
money in the Treasury not otherwise appropriated--
``(A) for fiscal year 2005, $7,000,000,000;
``(B) for fiscal year 2006, $7,000,000,000;
``(C) for fiscal year 2007, $3,000,000,000;
``(D) for fiscal year 2008, $3,000,000,000;
``(E) for fiscal year 2009, $6,000,000,000;
``(F) for fiscal year 2010, $7,000,000,000;
``(G) for fiscal year 2011, $8,000,000,000;
``(H) for fiscal year 2012, $9,000,000,000; and
``(I) for fiscal year 2013 and each fiscal year
thereafter, the amount of the allotment provided under
this paragraph for the preceding fiscal year increased
by the percentage increase (if any) in the medical care
expenditure category of the Consumer Price Index for
All Urban Consumers (United States city average).
``(2) State and territorial allotments.--
``(A) In general.--In addition to the allotments
provided under subsections (b) and (c), subject to
paragraphs (3) and (4), of the amount available for the
additional allotments under paragraph (1) for a fiscal
year, the Secretary shall allot to each State with a
State child health plan approved under this title--
``(i) in the case of such a State other
than a commonwealth or territory described in
clause (ii), the same proportion as the
proportion of the State's allotment under
subsection (b) (determined without regard to
subsection (f)) to 98.95 percent of the total
amount of the allotments under such section for
such States eligible for an allotment under
this subparagraph for such fiscal year; and
``(ii) in the case of a commonwealth or
territory described in subsection (c)(3), the
same proportion as the proportion of the
commonwealth's or territory's allotment under
subsection (c) (determined without regard to
subsection (f)) to 1.05 percent of the total
amount of the allotments under such section for
commonwealths and territories eligible for an
allotment under this subparagraph for such
fiscal year.
``(B) Availability and redistribution of unused
allotments.--In applying subsections (e) and (f) with
respect to additional allotments made available under
this subsection, the procedures established under such
subsections shall ensure such additional allotments are
only made available to States which have elected to
provide coverage under section 2111.
``(3) Use of additional allotment.--Additional allotments
provided under this subsection are not available for amounts
expended before October 1, 2004. Such amounts are available for
amounts expended on or after such date for child health
assistance for targeted low-income children, as well as for
parent health assistance for targeted low-income parents, and
health care assistance for targeted low-income pregnant women.
``(4) Requiring election to provide coverage.--No payments
may be made to a State under this title from an allotment
provided under this subsection unless the State has made an
election to provide parent health assistance for targeted low-
income parents, or health care assistance for targeted low-
income pregnant women.''.
(ii) Conforming amendments.--Section 2104
of the Social Security Act (42 U.S.C. 1397dd)
is amended--
(I) in subsection (a), by inserting
``subject to subsection (d),'' after
``under this section,'';
(II) in subsection (b)(1), by
inserting ``and subsection (d)'' after
``Subject to paragraph (4)''; and
(III) in subsection (c)(1), by
inserting ``subject to subsection
(d),'' after ``for a fiscal year,''.
(C) No cost-sharing for pregnancy-related
benefits.--Section 2103(e)(2) of the Social Security
Act (42 U.S.C. 1397cc(e)(2)) is amended--
(i) in the heading, by inserting ``and
pregnancy-related services'' after ``preventive
services''; and
(ii) by inserting before the period at the
end the following: ``and for pregnancy-related
services''.
(3) Effective date.--The amendments made by this subsection
apply to items and services furnished on or after October 1,
2004, whether or not regulations implementing such amendments
have been issued.
(b) Rules for Implementation Beginning With Fiscal Year 2006.--
(1) Expansion of availability of enhanced match under
medicaid for pre-chip expansions.--Paragraph (4) of section
1905(u) of the Social Security Act (42 U.S.C. 1396d(u)), as
inserted by subsection (a)(1)(C), is amended--
(A) by amending clause (ii) of subparagraph (A) to
read as follows:
``(ii) Certain pregnant women.--Expenditures for
medical assistance for pregnant women under section
1902(l)(1)(A) in a family the income of which exceeds
the 133 percent of the income official poverty line,
but only if the income level established under section
1902(l)(2) (or under a Statewide waiver under section
1115) for pregnant women is 185 percent of the income
official poverty line.''; and
(B) by adding at the end the following:
``(B) Children in families with income above medicaid
mandatory level not previously described.--The expenditures
described in this subparagraph are expenditures (other than
expenditures described in paragraph (2) or (3)) for medical
assistance made available to any child who is eligible for
assistance under section 1902(a)(10)(A) (other than under
clause (i)) and the income of whose family exceeds the minimum
income level required under subsection 1902(l)(2) (or, if
higher, the minimum level required under section 1931 for that
State) for a child of the age involved (treating any child who
is 19 or 20 years of age as being 18 years of age).''.
(2) Offset of additional expenditures for enhanced match
for pre-chip expansion.--Section 1905 of the Social Security
Act (42 U.S.C. 1396d) is amended--
(A) in the fourth sentence of subsection (b), by
inserting ``(except in the case of expenditures
described in subsection (u)(5))'' after ``do not
exceed'';
(B) in subsection (u), by inserting after paragraph
(4) (as inserted by subparagraph (C)), the following:
``(5) For purposes of the fourth sentence of subsection (b) and
section 2105(a), the following payments under this title do not count
against a State's allotment under section 2104:
``(A) Regular fmap for expenditures for pregnant women with
income above 133 percent of poverty.--The portion of the
payments made for expenditures described in paragraph
(4)(A)(ii) that represents the amount that would have been paid
if the enhanced FMAP had not been substituted for the Federal
medical assistance percentage.
``(B) FamilyCare parents.--Payments for expenditures
described in paragraph (4)(A)(i).
``(C) Regular fmap for expenditures for certain children in
families with income above medicaid mandatory level.--The
portion of the payments made for expenditures described in
paragraph (4)(B) that represents the amount that would have
been paid if the enhanced FMAP had not been substituted for the
Federal medical assistance percentage.''.
(C) Conforming amendments.--Subparagraph (B) of
section 2105(a)(1) of the Social Security Act, as
amended by subsection (a)(1)(D), is amended to read as
follows:
``(B) Certain familycare parents and others.--
Expenditures for medical assistance that is
attributable to expenditures described in section
1905(u)(4), except as provided in section
1905(u)(5).''.
(3) Effective date.--The amendments made by this subsection
apply as of October 1, 2005, to fiscal years beginning on or
after such date and to expenditures under the State plan on and
after such date, whether or not regulations implementing such
amendments have been issued.
(c) Making Title XXI Base Allotments Permanent.--Section 2104(a) of
the Social Security Act (42 U.S.C. 1397dd(a)) is amended--
(1) by striking ``and'' at the end of paragraph (9);
(2) by striking the period at the end of paragraph (10) and
inserting ``; and''; and
(3) by adding at the end the following:
``(11) for fiscal year 2008 and each fiscal year
thereafter, the amount of the allotment provided under this
subsection for the preceding fiscal year increased by the
percentage increase (if any) in the medical care expenditure
category of the Consumer Price Index for All Urban Consumers
(United States city average).''.
(d) GAO Study.--
(1) Study.--The Comptroller General of the United States
shall conduct a study regarding funding under title XXI of the
Social Security Act that examines--
(A) the adequacy of overall funding under such
title;
(B) the formula for determining allotments and for
redistribution of unspent funds under such title; and
(C) the effect of waiting lists and caps on
enrollment under such title.
(2) Report.--Not later than July 1, 2006, the Comptroller
General shall submit a report on the study conducted under
paragraph (1). Such report shall include recommendations
regarding a better mechanism for determining State allotments
and redistribution of unspent funds under such title in order
to ensure all eligible families in need can access coverage
through such title.
(e) Conforming Amendments.--
(1) Eligibility categories.--Section 1905(a) of the Social
Security Act (42 U.S.C. 1396d(a)) is amended, in the matter
before paragraph (1)--
(A) by striking ``or'' at the end of clause (xii);
(B) by inserting ``or'' at the end of clause
(xiii); and
(C) by inserting after clause (xiii) the following:
``(xiv) who are parents described (or treated as if
described) in section 1902(k)(1),''.
(2) Income limitations.--Section 1903(f)(4) of the Social
Security Act (42 U.S.C. 1396b(f)(4)) is amended--
(A) effective October 1, 2005, by inserting
``1902(a)(10)(A)(i)(VIII),'' after
``1902(a)(10)(A)(i)(VII),''; and
(B) by inserting ``1902(a)(10)(A)(ii)(XIX),'' after
``1902(a)(10)(A)(ii)(XVIII),''.
(3) Conforming amendment relating to no waiting period for
pregnant women.--Section 2102(b)(1)(B) of the Social Security
Act (42 U.S.C. 1397bb(b)(1)(B)) is amended--
(A) by striking ``, and'' at the end of clause (i)
and inserting a semicolon;
(B) by striking the period at the end of clause
(ii) and inserting ``; and''; and
(C) by adding at the end the following:
``(iii) may not apply a waiting period
(including a waiting period to carry out
paragraph (3)(C)) in the case of a targeted
low-income parent who is pregnant.''.
SEC. 4. AUTOMATIC ENROLLMENT OF CHILDREN BORN TO TITLE XXI PARENTS.
Section 2102(b)(1) of the Social Security Act (42 U.S.C.
1397bb(b)(1)) is amended by adding at the end the following:
``(C) Automatic eligibility of children born to a
parent being provided familycare.--Such eligibility
standards shall provide for automatic coverage of a
child born to an individual who is provided assistance
under this title in the same manner as medical
assistance would be provided under section 1902(e)(4)
to a child described in such section.''.
SEC. 5. OPTIONAL COVERAGE OF LEGAL IMMIGRANTS UNDER THE MEDICAID
PROGRAM AND TITLE XXI.
(a) Medicaid Program.--Section 1903(v) of the Social Security Act
(42 U.S.C. 1396b(v)) is amended--
(1) in paragraph (1), by striking ``paragraph (2)'' and
inserting ``paragraphs (2) and (4)''; and
(2) by adding at the end the following:
``(4)(A) A State may elect (in a plan amendment under this title)
to provide medical assistance under this title for aliens who are
lawfully residing in the United States (including battered aliens
described in section 431(c) of the Personal Responsibility and Work
Opportunity Reconciliation Act of 1996) and who are otherwise eligible
for such assistance, within any of the following eligibility
categories:
``(i) Pregnant women.--Women during pregnancy (and during
the 60-day period beginning on the last day of the pregnancy).
``(ii) Children.--Children (as defined under such plan),
including optional targeted low-income children described in
section 1905(u)(2)(B).
``(iii) Parents.--If the State has elected the eligibility
category described in clause (ii), caretaker relatives who are
parents (including individuals treated as a caretaker for
purposes of carrying out section 1931) of children (described
in such clause or otherwise) who are eligible for medical
assistance under the plan.
``(B)(i) In the case of a State that has elected to provide medical
assistance to a category of aliens under subparagraph (A), no debt
shall accrue under an affidavit of support against any sponsor of such
an alien on the basis of provision of assistance to such category and
the cost of such assistance shall not be considered as an unreimbursed
cost.
``(ii) The provisions of sections 401(a), 402(b), 403, and 421 of
the Personal Responsibility and Work Opportunity Reconciliation Act of
1996 shall not apply to a State that makes an election under
subparagraph (A).''.
(b) Title XXI.--Section 2107(e)(1) of the Social Security Act (42
U.S.C. 1397gg(e)(1)) is amended by adding at the end the following:
``(E) Section 1903(v)(4) (relating to optional
coverage of permanent resident alien children and
parents), but only if the State has elected to apply
such section to that category of children under title
XIX.''.
(c) Effective Date.--The amendments made by this section take
effect on October 1, 2004, and apply to medical assistance and child
health assistance furnished on or after such date, whether or not
regulations implementing such amendments have been issued.
SEC. 6. OPTIONAL COVERAGE OF CHILDREN THROUGH AGE 20 UNDER THE MEDICAID
PROGRAM AND TITLE XXI.
(a) Medicaid.--
(1) In general.--Section 1902(l)(1)(D) of the Social
Security Act (42 U.S.C. 1396a(l)(1)(D)) is amended by inserting
``(or, at the election of a State, 20 or 21 years of age)''
after ``19 years of age''.
(2) Conforming amendments.--
(A) Section 1902(e)(3)(A) of the Social Security
Act (42 U.S.C. 1396a(e)(3)(A)) is amended by inserting
``(or 1 year less than the age the State has elected
under subsection (l)(1)(D))'' after ``18 years of
age''.
(B) Section 1902(e)(12) of the Social Security Act
(42 U.S.C. 1396a(e)(12)) is amended by inserting ``or
such higher age as the State has elected under
subsection (l)(1)(D)'' after ``19 years of age''.
(C) Section 1920A(b)(1) of the Social Security Act
(42 U.S.C. 1396r-1a(b)(1)) is amended by inserting ``or
such higher age as the State has elected under section
1902(l)(1)(D)'' after ``19 years of age''.
(D) Section 1928(h)(1) of the Social Security Act
(42 U.S.C. 1396s(h)(1)) is amended by inserting ``or 1
year less than the age the State has elected under
section 1902(l)(1)(D)'' before the period at the end.
(E) Section 1932(a)(2)(A) of the Social Security
Act (42 U.S.C. 1396u-2(a)(2)(A)) is amended by
inserting ``(or such higher age as the State has
elected under section 1902(l)(1)(D))'' after ``19 years
of age''.
(b) Title XXI.--Section 2110(c)(1) of the Social Security Act (42
U.S.C. 1397jj(c)(1)) is amended by inserting ``(or such higher age as
the State has elected under section 1902(l)(1)(D))''.
(c) Effective Date.--The amendments made by this section take
effect on January 1, 2005, and apply to medical assistance and child
health assistance provided on or after such date, whether or not
regulations implementing such amendments have been issued.
SEC. 7. ALLOWING STATES TO SIMPLIFY RULES FOR FAMILIES.
(a) Presumptive Eligibility.--
(1) Application to presumptive eligibility for pregnant
women under medicaid.--Section 1920(b) of the Social Security
Act (42 U.S.C. 1396r-1(b)) is amended by adding at the end
after and below paragraph (2) the following flush sentence:
``The term `qualified provider' includes a qualified entity as defined
in section 1920A(b)(3).''.
(2) Optional application of presumptive eligibility
provisions to parents.--Section 1920A of the Social Security
Act (42 U.S.C. 1396r-1a) is amended by adding at the end the
following:
``(e) A State may elect to apply the previous provisions of this
section to provide for a period of presumptive eligibility for medical
assistance for a parent of a child with respect to whom such a period
is provided under this section.''.
(3) Application under title xxi.--Section 2107(e)(1)(D) of
the Social Security Act (42 U.S.C. 1397gg(e)(1)) is amended to
read as follows:
``(D) Sections 1920 and 1920A (relating to
presumptive eligibility).''.
(b) 12-Months Continuous Eligibility.--
(1) Medicaid.--Section 1902(e)(12) of the Social Security
Act (42 U.S.C. 1396a(e)(12)) is amended--
(A) by striking ``At the option of the State, the
plan may'' and inserting ``The plan shall'';
(B) by striking ``an age specified by the State
(not to exceed 19 years of age)'' and inserting ``19
years of age (or such higher age as the State has
elected under subsection (l)(1)(D)) or, at the option
of the State, who is eligible for medical assistance as
the parent of such a child''; and
(C) in subparagraph (A), by striking ``a period
(not to exceed 12 months) '' and inserting ``the 12-
month period beginning on the date''.
(2) Title XXI.--Section 2102(b)(2) of such Act (42 U.S.C.
1397bb(b)(2)) is amended by adding at the end the following:
``Such methods shall provide continuous eligibility for
children under this title in a manner that is no less generous
than the 12-months continuous eligibility provided under
section 1902(e)(12) for children described in such section
under title XIX. If a State has elected to apply section
1902(e)(12) to parents, such methods may provide continuous
eligibility for parents under this title in a manner that is no
less generous than the 12-months continuous eligibility
provided under such section for parents described in such
section under title XIX.''.
(3) Effective date.--The amendments made by this subsection
shall take effect on July 1, 2005, whether or not regulations
implementing such amendments have been issued.
(c) Provision of Medicaid and CHIP Applications and Information
Under the School Lunch Program.--Section 9(b)(2)(B) of the Richard B.
Russell National School Lunch Act (42 U.S.C. 1758(b)(2)(B)) is
amended--
(1) by striking ``(B) Applications'' and inserting ``(B)(i)
Applications''; and
(2) by adding at the end the following:
``(ii)(I) Applications for free and reduced price lunches that are
distributed pursuant to clause (i) to parents or guardians of children
in attendance at schools participating in the school lunch program
under this Act shall also contain information on the availability of
medical assistance under title XIX of the Social Security Act (42
U.S.C. 1396 et seq.) and of child health and FamilyCare assistance
under title XXI of such Act, including information on how to obtain an
application for assistance under such programs.
``(II) Information on the programs referred to in subclause (I)
shall be provided on a form separate from the application form for free
and reduced price lunches under clause (i).''.
SEC. 8. REVISION AND SIMPLIFICATION OF THE TRANSITIONAL MEDICAL
ASSISTANCE PROGRAM (TMA).
(a) Making Reporting Requirements Optional; Option of Extended
Eligibility.--
(1) Option for making reporting requirements optional.--
Section 1925(b) of the Social Security Act (42 U.S.C. 1396r-
6(b)) is amended--
(A) in paragraph (1), by inserting ``, at the
option of a State,'' after ``and which'';
(B) in paragraph (2)(A), by inserting ``Subject to
subparagraph (C)--'' after ``(A) Notices.--'';
(C) in paragraph (2)(B), by inserting ``Subject to
subparagraph (C)--'' after ``(B) Reporting
requirements.--'';
(D) by adding at the end the following new
subparagraph:
``(C) State option to waive notice and reporting
requirements.--A State may waive some or all of the
reporting requirements under clauses (i) and (ii) of
subparagraph (B). Insofar as it waives such a
reporting requirement, the State need not provide for a notice under
subparagraph (A) relating to such requirement.''; and
(E) in paragraph (3)(A)(iii), by inserting ``the
State has not waived under paragraph (2)(C) the
reporting requirement with respect to such month under
paragraph (2)(B) and if'' after ``6-month period if''.
(2) State option to extend eligibility for low-income
individuals for up to 12 additional months.--Section 1925 of
such Act (42 U.S.C. 1396r-6) is further amended--
(A) by redesignating subsections (c) through (f) as
subsections (d) through (g); and
(B) by inserting after subsection (b) the following
new subsection:
``(c) State Option of Up to 12 Months of Additional Eligibility.--
``(1) In general.--Notwithstanding any other provision of
this title, each State plan approved under this title may
provide, at the option of the State, that the State shall offer
to each family which received assistance during the entire 6-
month period under subsection (b) and which meets the
applicable requirement of paragraph (2), in the last month of
the period the option of extending coverage under this
subsection for the succeeding period not to exceed 12 months.
``(2) Income restriction.--The option under paragraph (1)
shall not be made available to a family for a succeeding period
unless the State determines that the family's average gross
monthly earnings (less such costs for such child care as is
necessary for the employment of the caretaker relative) as of
the end of the 6-month period under subsection (b) does not
exceed 185 percent of the official poverty line (as defined by
the Office of Management and Budget, and revised annually in
accordance with section 673(2) of the Omnibus Budget
Reconciliation Act of 1981) applicable to a family of the size
involved.
``(3) Application of extension rules.--The provisions of
paragraphs (2), (3), (4), and (5) of subsection (b) shall apply
to the extension provided under this subsection in the same
manner as they apply to the extension provided under subsection
(b)(1), except that for purposes of this subsection--
``(A) any reference to a 6-month period under
subsection (b)(1) is deemed a reference to the
extension period provided under paragraph (1) and any
deadlines for any notices or reporting and the premium
payment periods shall be modified to correspond to the
appropriate calendar quarters of coverage provided
under this subsection; and
``(B) any reference to a provision of subsection
(a) or (b) is deemed a reference to the corresponding
provision of subsection (b) or of this subsection,
respectively.''.
(b) State Option To Waive Receipt of Medicaid for 3 of Previous 6
Months To Qualify for TMA.--Section 1925(a)(1) of such Act (42 U.S.C.
1396r-6(a)(1)) is amended by adding at the end the following: ``A State
may, at its option, also apply the previous sentence in the case of a
family that was receiving such aid for fewer than 3 months, or that had
applied for and was eligible for such aid for fewer than 3 months,
during the 6 immediately preceding months described in such
sentence.''.
(c) Elimination of Sunset for TMA.--
(1) Subsection (g) of section 1925 of such Act (42 U.S.C.
1396r-6), as redesignated under subsection (a)(2), is repealed.
(2) Section 1902(e)(1) of such Act (42 U.S.C. 1396a(e)(1))
is amended by striking ``(A) Nothwithstanding'' and all that
follows through ``During such period, for'' in subparagraph (B)
and inserting ``For''.
(d) CMS Report on Enrollment and Participation Rates Under TMA.--
Section 1925 of such Act, as amended by subsections (a)(2) and (c)(1),
is amended by adding at the end the following new subsection:
``(g) Additional Provisions.--
``(1) Collection and reporting of participation
information.--Each State shall--
``(A) collect and submit to the Secretary, in a
format specified by the Secretary, information on
average monthly enrollment and average monthly
participation rates for adults and children under this
section; and
``(B) make such information publicly available.
Such information shall be submitted under subparagraph (A) at
the same time and frequency in which other enrollment
information under this title is submitted to the Secretary.
Using such information, the Secretary shall submit to Congress
annual reports concerning such rates.''.
(e) Coordination of Work.--Section 1925(g) of such Act, as added by
subsection (d), is amended by adding at the end the following new
paragraph:
``(2) Coordination with administration for children and
families.--The Administrator of the Centers for Medicare &
Medicaid Services, in carrying out this section, shall work
with the Assistant Secretary for the Administration for
Children and Families to develop guidance or other technical
assistance for States regarding best practices in guaranteeing
access to transitional medical assistance under this
section.''.
(f) Elimination of TMA Requirement for States That Extend Coverage
to Children and Parents Through 185 Percent of Poverty.--
(1) In general.--Section 1925 of such Act is further
amended by adding at the end the following new subsection:
``(h) Provisions Optional for States That Extend Coverage to
Children and Parents Through 185 Percent of Poverty.--A State may (but
is not required to) meet the requirements of subsections (a) and (b) if
it provides for medical assistance under section 1931 to families
(including both children and caretaker relatives) the average gross
monthly earning of which (less such costs for such child care as is
necessary for the employment of a caretaker relative) is at or below a
level that is at least 185 percent of the official poverty line (as
defined by the Office of Management and Budget, and revised annually in
accordance with section 673(2) of the Omnibus Budget Reconciliation Act
of 1981) applicable to a family of the size involved.''.
(2) Conforming amendments.--Such section is further
amended, in subsections (a)(1) and (b)(1), by inserting ``, but
subject to subsection (h),'' after ``Notwithstanding any other
provision of this title,'' each place it appears.
(g) Extending Use of Outstationed Workers To Accept Applications
for Transitional Medical Assistance.--Section 1902(a)(55) of such Act
(42 U.S.C. 1396a(a)(55)) is amended by inserting ``and under section
1931'' after ``(a)(10)(A)(ii)(IX)''.
(h) Effective Dates.--(1) Except as provided in this subsection,
the amendments made by this section shall apply to calendar quarters
beginning on or after the date of the enactment of this Act, without
regard to whether or not final regulations to carry out such amendments
have been promulgated by such date.
(2) In the case of a State plan for medical assistance under title
XIX of the Social Security Act which the Secretary of Health and Human
Services determines requires State legislation (other than legislation
appropriating funds) in order for the plan to meet the additional
requirements imposed by the amendments made by this section, the State
plan shall not be regarded as failing to comply with the requirements
of such title solely on the basis of its failure to meet these
additional requirements before the first day of the first calendar
quarter beginning after the close of the first regular session of the
State legislature that begins after the date of the enactment of this
Act. For purposes of the previous sentence, in the case of a State that
has a 2-year legislative session, each year of such session shall be
deemed to be a separate regular session of the State legislature.
SEC. 9. LIMITATIONS ON CONFLICTS OF INTEREST.
(a) Limitation on Conflicts of Interest in Marketing Activities.--
(1) Title xxi.--Section 2105(c) of the Social Security Act
(42 U.S.C. 300aa-5(c)) is amended by adding at the end the
following:
``(8) Limitation on expenditures for marketing
activities.--Amounts expended by a State for the use of an
administrative vendor in marketing health benefits coverage to
low-income children under this title shall not be considered,
for purposes of subsection (a)(2)(D), to be reasonable costs to
administer the plan unless the following conditions are met
with respect to the vendor:
``(A) The vendor is independent of any entity
offering the coverage in the same area of the State in
which the vendor is conducting marketing activities.
``(B) No person who is an owner, employee,
consultant, or has a contract with the vendor either
has any direct or indirect financial interest with such
an entity or has been excluded from participation in
the program under this title or title XVIII or XIX or
debarred by any Federal agency, or subject to a civil
money penalty under this Act.''.
(b) Prohibition of Affiliation With Debarred Individuals.--
(1) Medicaid.--Section 1903(i) of the Social Security Act
(42 U.S.C. 1396b(i))is amended--
(A) by striking the period at the end of paragraph
(20) and inserting ``; or''; and
(B) by inserting after paragraph (20) the
following:
``(21) with respect to any amounts expended for an entity
that receives payments under the plan unless--
``(A) no person with an ownership or control
interest (as defined in section 1124(a)(3)) in the
entity is a person that is debarred, suspended, or
otherwise excluded from participating in procurement or
non-procurement activities under the Federal
Acquisition Regulation; and
``(B) such entity has not entered into an
employment, consulting, or other agreement for the
provision of items or services that are material to
such entity's obligations under the plan with a person
described in subparagraph (A).''.
(2) Title xxi.--Section 2107(e)(1) of the Social Security
Act (42 U.S.C. 1397gg(e)(1)), as amended by section 5(b), is
further amended--
(A) in subparagraph (B), by striking ``and (17)''
and inserting ``(17), and (21)''; and
(B) by adding at the end the following:
``(F) Section 1902(a)(67) (relating to prohibition
of affiliation with debarred individuals).''.
(c) Effective Date.--The amendments made by this section shall
apply to expenditures made on or after July 1, 2005, whether or not
regulations implementing such amendments have been issued.
SEC. 10. INCREASE IN CHIP ALLOTMENT FOR EACH OF FISCAL YEARS 2002
THROUGH 2004.
Effective as if included in the enactment of the Balanced Budget
Act of 1997, paragraphs (5), (6), and (7) of section 2104(a) of the
Social Security Act (42 U.S.C. 1397dd(a)) are amended by striking
``$3,150,000,000'' each place it appears and inserting
``$4,150,000,000''.
SEC. 11. DEMONSTRATION PROGRAMS TO IMPROVE MEDICAID AND CHIP OUTREACH
TO HOMELESS INDIVIDUALS AND FAMILIES.
(a) Authority.--The Secretary of Health and Human Services may
award demonstration grants to not more than 7 States (or other
qualified entities) to conduct innovative programs that are designed to
improve outreach to homeless individuals and families under the
programs described in subsection (b) with respect to enrollment of such
individuals and families under such programs and the provision of
services (and coordinating the provision of such services) under such
programs.
(b) Programs for Homeless Described.--The programs described in
this subsection are as follows:
(1) Medicaid.--The program under title XIX of the Social
Security Act (42 U.S.C. 1396 et seq.).
(2) CHIP.--The program under title XXI of the Social
Security Act (42 U.S.C. 1397aa et seq.).
(3) TANF.--The program under part of A of title IV of the
Social Security Act (42 U.S.C. 601 et seq.).
(4) SAMHSA block grants.--The program of grants under part
B of title XIX of the Public Health Service Act (42 U.S.C.
300x-1 et seq.).
(5) Food stamp program.--The program under the Food Stamp
Act of 1977 (7 U.S.C. 2011 et seq.).
(6) Workforce investment act.--The program under the
Workforce Investment Act of 1999 (29 U.S.C. 2801 et seq.).
(7) Welfare-to-work.--The welfare-to-work program under
section 403(a)(5) of the Social Security Act (42 U.S.C.
603(a)(5)).
(8) Other programs.--Other public and private benefit
programs that serve low-income individuals.
(c) Appropriations.--For the purposes of carrying out this section,
there is appropriated for fiscal year 2005, out of any funds in the
Treasury not otherwise appropriated, $10,000,000, to remain available
until expended.
SEC. 12. ADDITIONAL CHIP REVISIONS.
(a) Limiting Cost-Sharing to 2.5 Percent for Families With Income
Below 150 Percent of Poverty.--Section 2103(e)(3)(A) of the Social
Security Act (42 U.S.C. 1397cc(e)(3)(A)) is amended--
(1) by striking ``and'' at the end of clause (i);
(2) by striking the period at the end of clause (ii) and
inserting ``; and''; and
(3) by adding at the end the following new clause:
``(iii) total annual aggregate cost-sharing
described in clauses (i) and (ii) with respect
to all such targeted low-income children in a
family under this title that exceeds 2.5
percent of such family's income for the year
involved.''.
(b) Employer Coverage Waiver Changes.--Section 2105(c)(3) of such
Act (42 U.S.C. 1397ee(c)(3)) is amended--
(1) by redesignating subparagraphs (A) and (B) as clauses
(i) and (ii) and indenting appropriately;
(2) by designating the matter beginning with ``Payment may
be made'' as a subparagraph (A) with the heading ``In general''
and indenting appropriately; and
(3) by adding at the end the following new subparagraph:
``(B) Application of requirements.--In carrying out
subparagraph (A)--
``(i) in determining cost-effectiveness,
the Secretary shall measure against family
coverage costs to the extent that a State has
expanded coverage to parents pursuant to
section 2111;
``(ii) subject to clause (iii), the State
shall provide satisfactory assurances that the
minimum benefits and cost-sharing protections
established under this title are provided,
either through the coverage under subparagraph
(A) or as a supplement to such coverage; and
``(iii) coverage under such subparagraph
shall not be considered to violate clause (ii)
because it does not comply with requirements
relating to reviews of health service decisions
if the enrollee involved is provided the option
of being provided benefits directly under this
title.''.
(c) Effective Date.--The amendments made by this section apply as
of January 1, 2005, whether or not regulations implementing such
amendments have been issued.
SEC. 13. INCREASED FEDERAL REIMBURSEMENT FOR LANGUAGE SERVICES UNDER
THE MEDICAID PROGRAM AND TITLE XXI.
(a) Medicaid.--Section 1903(a)(3) of the Social Security Act (42
U.S.C. 1396b(a)(3)) is amended--
(1) in subparagraph (D), by striking ``plus'' at the end
and inserting ``and''; and
(2) by adding at the end the following:
``(E) 90 percent of the sums expended with respect
to costs incurred during such quarter as are
attributable to the provision of language services,
including oral interpretation, translations of written
materials, and other language services, for individuals
with limited English proficiency who apply for, or
receive, medical assistance under the State plan;
plus''.
(b) SCHIP.--Section 2105(a)(1) of the Social Security Act (42
U.S.C.1397ee(a)) is amended--
(1) in the matter preceding subparagraph (A), by inserting
``or, in the case of expenditures described in subparagraph
(D)(iv), 90 percent'' after ``enhanced FMAP''; and
(2) in subparagraph (D)--
(A) in clause (iii), by striking ``and'' at the
end;
(B) be redesignating clause (iv) as clause (v); and
(C) by inserting after clause (iii) the following:
``(iv) for expenditures attributable to the
provision of language services, including oral
interpretation, translations of written
materials, and other language services, for
individuals with limited English proficiency
who apply for, or receive, child health
assistance under the plan; and''.
(c) Effective Date.--The amendments made by this section take
effect on January 1, 2005.
<all>
Introduced in House
Introduced in House
Referred to the House Committee on Energy and Commerce.
Referred to the Subcommittee on Health.
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